Basic Information
| Provider Information | |||||||||
| NPI: | 1134548589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRINCE | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 834 CHESTNUT ST | ||||||||
| Address2: | APARTMENT 1712 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159905103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD STE 2B80 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026515874 | ||||||||
| FaxNumber: | 3026515954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2014 | ||||||||
| LastUpdateDate: | 12/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD460569 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.